Cushing's disease demands a structured, evidence-based approach guided by specific clinical goals. The protocol establishes a clear first-line intervention, defines the expertise and centre requirements for that intervention, and sets the remission criteria that determine success.

First-Line Intervention

Pituitary surgery is the established first-line treatment, and the protocol specifies precise requirements around surgical expertise and the type of centre where the procedure should be performed. The complete regimen — including the specific procedure, centre criteria, and care team composition — is in the full protocol.

The detailed treatment algorithm is available via the button below.

Treatment Goal

The primary endpoint is biochemical remission, confirmed through post-operative serum cortisol measurement against a defined threshold. The protocol specifies this threshold and the monitoring schedule used to verify it.

References

DOI: 10.1016/S2213-8587(21)00235-7

Transsphenoidal surgery (TSS) is recommended as first-line therapy for patients with CD.
We recommend patients with CD undergo surgery in specialized Pituitary Tumor Centers of Excellence (PTCOE) wherever possible.
Surgery should be performed by an experienced pituitary neurosurgeon and follow-up conducted by a multidisciplinary team including a pituitary endocrinologist.
Remission, typically defined as postoperative serum cortisol <55 nmol/L (<2 μg/dL), is seen in approximately 80% of patients with microadenomas and 60% with macroadenomas if the procedure is performed by an experienced surgeon.

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What Is the Recommended First-Line Treatment for Cushing's Disease?

First-Line Intervention

Treatment Goal

References